Surgical robot, instrument manipulator, combination of an operating table and a surgical robot, and master-slave operating system

ABSTRACT

The present invention relates to a surgical robot for performing surgery of the minimally invasive type, comprising an instrument manipulator having a manipulator front end, which is provided with an instrument receiver for receiving therein a surgical instrument, and manipulating means for, at least in use, manipulating the manipulator front end with respect to a patient body. The manipulator front end further comprises a container for receiving therein the surgical instrument. The invention further relates to an instrument manipulator, a combination of an operating table and a surgical robot, and a master-slave operating system.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a continuation-in-part of U.S. patent applicationSer. No. 13/499,374 filed Mar. 30, 2012, which is incorporated herein byreference. U.S. patent application Ser. No. 13/499,374 filed Mar. 30,2012 is a 371 of PCT Patent Application PCT/NL2010/050641 filed Oct. 1,2010, which claims the benefit of Dutch Application NL1037348 filed Oct.2, 2009.

FIELD OF THE INVENTION

The invention relates to surgical robots and manipulators.

DESCRIPTION

The present invention relates to a surgical robot for performing surgeryof the minimally invasive type, comprising an instrument manipulatorhaving a manipulator front end which is provided with an instrumentreceiver for receiving therein one of a number of surgical instruments,and manipulating means for, at least in use manipulating the manipulatorfront end with respect to a patient body.

The present invention further relates to an instrument manipulator, acombination of an operating table and a surgical robot, and amaster-slave operating system.

WO 2008/036304 describes a master-slave operating system. Said operatingsystem for performing ophthalmic microsurgery comprises a tele-roboticmaster and a slave robot, the slave robot being a surgical robot of thekind mentioned in the introduction, which surgical robot is connected tothe master. A medical professional (surgeon) controls manipulation ofthe slave robot by manually actuating controllers on the master. Theslave robot comprises a frame, which is connected to a patient tableand/or to the patient's head. The slave robot comprises a manipulatorfront end to which a surgical instrument can be attached, andmanipulation means for manipulation of the front end with respect to thepatient's head (eye). Multiple slave robots can be used, which can beequipped with various instruments. A disadvantage of the known surgicalrobot is that switching an instrument of a particular robot is amanually performed, time-consuming and complex procedure, in which thefocus of the surgeon is taken away from the point of operation. Theobject of the present invention is to provide a solution for theabove-mentioned problems, or at least an improvement in that regard. Inorder to achieve that object, the surgical robot according to theinvention is characterized in that the manipulator front end furthercomprises a container having a number of container holders for receivingtherein the number of surgical instruments, and switching means forswitching the instrument present in the instrument receiver by aninstrument present in a container holder. An advantage of the provisionof an instrument container in combination with the switching means onthe front end of the instrument manipulator is that instruments can beswitched automatically, quickly, and that without the need ofmanipulation of the front end with respect to the patient's body. As aresult an instrument can be switched in a safe and quick manner, inwhich the focus of the surgeon is not taken away from the point ofoperation.

Although the surgical robot according to the present invention isdesigned for performing ophthalmic surgery, use of the robot for other(micro)surgical interventions on a human or animal body is included inthe scope of the present invention.

Preferably the manipulator front end comprises a base body that can beconnected to the manipulating means, wherein the container is moveablewith respect to the base body, such that each respective containerholder is placeable in alignment with the instrument receiver. In thisway switching an instrument is simplified, wherein during an instrumentswitch the spatial position (with respect to the patient body) of thebase body can be fixed, and the container moves with respect to the basebody in order to switch an instrument.

It is advantageous if the switching means comprise a guide which is, ina longitudinal direction of the instrument receiver, provided on themanipulator front end, to which guide at least one of the instrumentreceiver and the container is connected, for moving the container andthe instrument receiver towards and away from each other along theguide, in order to switch an instrument between the instrument receiverand a container holder. Due to the presence of said guide allowingrelative movement of the instrument receiver and/or the container, aninstrument can be switched very easily, since the instrument receiverand the container holder can be brought in direct proximity.

Preferably, the instrument receiver is provided with a passage in alongitudinal direction of the instrument receiver, in which passage aninstrument is moveable, whereby the instrument receiver furthercomprises fixing means for fixing an instrument in the instrumentreceiver in an active position of the fixing means, and releasing theinstrument in a passive position of the fixing means. In this way aninstrument can be easily fixed in the instrument receiver by sliding theinstrument into the passage of the instrument receiver. In this respectthe instrument receiver is preferably elongated and the passage ispreferably elongated.

In order to yield a simple though efficient construction, it ispreferable if the instrument receiver comprises a sleeve-shaped elementin which the passage is provided, and whereby the fixing means comprisea clamp ring which can be translated with respect to the sleeve-shapedelement in the longitudinal direction of the sleeve-shaped element, forchanging the fixing means from the active position to the passiveposition and vice versa under the influence of mutual translation of thesleeve-shaped element and the clamp ring.

Preferably, the switching means comprise a stop connected to one of theclamp ring and the sleeve-shaped element, and stop surfaces connected tothe other of the clamp ring and the sleeve-shaped element, which stopsurfaces are located on both sides of the stop, seen in the direction ofmutual translation of the sleeve-shaped element and the clamp ring, andwhich stop surfaces define the active position and the passive position.In this way the active and passive position can be easily and accuratelydefined.

Preferably, the stop surfaces form part of a stop element having a firstand a second oppositely located crown-shaped body, wherein the firstcrown-shaped body is circumferentially provided with slots on the sidefacing the second crown-shaped body, wherein the second crown-shapedbody is circumferentially provided with oblique sliding edges on theside facing the first crown-shaped body, which oblique sliding edgesform stop surfaces and are located opposite the slots, and wherein theends of the slots form stop surfaces. Using such crown-shaped bodies, ofwhich oblique sliding edges form stop surfaces on one side of the stop,and of which the ends of slots form stop surfaces at the opposite sideof the stop, the active or the passive position can be selected in aneasy manner.

In a preferred embodiment the ends of adjacent slots are disposed atalternating positions, seen in the direction of mutual translation ofthe sleeve-shaped element and the clamp ring, for defining the activeposition and the passive position. This results in a constructionsimilar to a push button type ballpoint (pen), in which by moving thestop with respect to the stop element, the active position and thepassive position are alternatively selected and that in a bistablemanner.

A simple construction is obtained if the stop element is formed by aposition ring which is rotatable with respect to the sleeve-shapedelement and which is provided around the sleeve-shaped element, and thatthe stop is formed by at least one pin which extends radially from theclamp ring to in between the stop surfaces.

It is advantageous if the switching means comprise a push elementlocated at the top of the instrument receiver, which push element isconnected to the clamp ring, which push element translates the clampring with respect to the sleeve-shaped element under the influence ofmutual translation of the instrument receiver and the container. Due tothe push element located at the top of the instrument receiver the clampring can be actuated by contacting from below the container with thepush element during the mutual translation. This results in a changefrom the active to the passive position of the fixing means, as a resultof which an instrument can be transferred from the instrument receiverto a container holder.

In a constructional embodiment the fixing means comprise a clamp elementfor fixing the instrument in the instrument receiver under the influenceof a clamping force, in the active position. In a preferred embodimentthe clamp element comprises a resilient lip, even more preferably anumber of lips, preferably three lips, evenly distributed around theperimeter of the passage.

A very simple though efficient construction is yielded if each one ofthe number of container holders is provided with an opening in which aninstrument is moveable, wherein each one of the number of containerholders comprises further fixing means for fixing one of the number ofinstruments in the respective container holder. Preferably the openingis elongated and having its longitudinal direction aligned with theabove-mentioned passage of the instrument receiver.

An additional advantage is obtained if the further fixing means comprisea further clamp element for fixing an instrument in the respectivecontainer holder under the influence of a further clamping force. Aclamp element is a simple solution for efficiently fixing an instrumentin a container holder. In a preferred embodiment the further clampelement comprises a resilient lip.

In order to realize a very easy and reliable transfer of an instrumentfrom a instrument receiver to a container holder and vice versa, it ispreferable if the clamping force exerted by the further clamp element onan instrument is smaller than the clamping force exerted by the clampelement on the respective instrument. In this way, if an instrument ispresent in a container holder, during a switch, that instrument justneeds to be fixed in the instrument receiver. Next, by moving theinstrument receiver away from the container, the instrument is pulledout of the container holder, since the clamping force exerted by thefurther clamp element on an instrument is smaller than the clampingforce exerted by the clamp element on the respective instrument.

In a preferred embodiment the manipulator front end comprises a cannulaconnection which is aligned with the instrument receiver, and which is,at least in use, positioned on the patient's body and through which aninstrument which is present in the instrument receiver is moveable,wherein the manipulator front end further comprises a guide to which theinstrument receiver is connected, for moving the instrument receiverwith respect to the manipulator front end along the guide in order tomove the instrument through the cannula connection. With such a definedand stiff connection between the cannula and the front end of theinstrument manipulator, a very safe switching of instruments can berealised, wherein the focus of the surgeon can be held within the organof intervention, thereby reducing the chance of error.

The present invention further relates to an instrument manipulator foruse in a surgical robot according to the present invention, having amanipulator front end which is provided with a instrument receiver forreceiving therein one of a number of surgical instruments, characterizedin that the manipulator front end further comprises a container having anumber of container holders for receiving therein the number of surgicalinstruments, and switching means for switching the instrument present inthe instrument receiver by an instrument present in a container holder.The advantages that can be achieved with such an instrument manipulatorhave already been explained in the foregoing in the description of thesurgical robot according to the invention.

The present invention still further relates to a combination of anoperating table and a surgical robot according to the present invention,wherein preferably the surgical robot is directly connected to theoperating table. In this way a very stiff connection between the tableand the robot is realised, and the robot can thus be positionedaccurately with respect to the patient body, and keep positionedaccurately during the surgery.

The present invention still further relates to a master-slave operatingsystem, wherein the slave comprises a surgical robot according to thepresent invention, and wherein the master is operatively connected tothe surgical robot and comprises actuating means for actuating thesurgical robot at the distance by a surgeon for, at least in use,performing a surgical treatment to a patient's body.

In such a master-slave operating system, it is preferable if the slavecomprises two surgical robots, wherein the actuating means comprise twoactuating elements for actuating one of the two respective surgicalrobots by each respective actuating element. The two actuating elementscan be controlled by both hands of the surgeon, by means of which thetwo robots can be controlled.

The invention will now be explained in more detail by means of adescription of a preferred embodiment of the present invention, in whichreference is made to the following figures:

FIGS. 1a and 1b show in front view and in isometric view, respectively,an operating table to which a preferred embodiment of a surgical robotaccording to the present invention is mounted;

FIG. 2 shows in isometric view an instrument manipulator of the surgicalrobot according to FIG. 1;

FIG. 3 shows in isometric view the manipulator front end of theinstrument manipulator of FIG. 2;

FIG. 4 shows in isometric view the manipulator front end of FIG. 3 inexploded view;

FIGS. 5a and 5b show in isometric and exploded view, respectively, theinstrument receiver of the manipulator front end according to FIG. 3.

FIG. 6 shows the instrument manipulator having a manipulator front end605. The manipulator front end 605 has a base body defining alongitudinal axis with a proximal end and a distal end. A container ismovably connected to the base body near the proximal end of thelongitudinal axis. The container has an instrument holder for holding asurgical instrument. The instrument holder has a through-hole forholding the surgical instrument. The through-hole has a proximal end anda distal end in the direction of the longitudinal axis. At least part ofthe surgical instrument when held in the instrument holder extends pastthe distal end of the through-hole and towards the distal end of thebase body. An instrument receiver receives the surgical instrument frombelow the distal end of the respective through-hole of the instrumentholder. The instrument receiver has a clamping mechanism to clamp thesurgical instrument when the clamping mechanism is changing from apassive no-clamping state to an active clamping state. A cannulaconnector 610 with a proximal end and a distal end both is alignedparallel with the longitudinal axis of the base body. The cannulaconnector 610 is a rigid connector mounted to the distal end of the basebody. The surgical instrument goes through the cannula connector 610.The cannula connector 610 remains distal to the instrument receiver andis parallel with the longitudinal axis of the instrument receiver. Thecannula connector 610 can be fixated onto a cannula to establish aconnection between the base body and the cannula via the cannulaconnector 610 such that the cannula is also aligned with thelongitudinal axis. A linear guide is used to actively guide theinstrument receiver towards the instrument holder such that theinstrument receiver can actively clamp the surgical instrument throughthe clamping mechanism. The linear guide can actively guide theinstrument receiver with the clamped surgical instrument in longitudinaldirection towards the cannula connector 610. The translation of theinstrument receiver towards the cannula connector 610, while thesurgical instrument is clamped by the clamping mechanism of theinstrument receiver, causes the surgical instrument to be released fromthe instrument holder.

In FIGS. 1a and 1b an operating table 6 is schematically shown. Theoperating table 6 serves as a support for a patient for ophthalmicmicrosurgery. A surgical robot system is provided in the operating roomin which table 6 is located, comprising a surgical robot 1 acting as aslave robot of a master system (not shown). A surgeon performs thesurgery by controlling the motion of the slave robot by manualmanipulation of controllers on the master system, whereby the surgicalrobot 1 performs the actual surgical operation on the patient. A controlunit (not shown) is provided which links the master to the robot 1. Thecontrol unit comprises motion and force controllers, amplifiers to driveactuators of instrument manipulators 20 of robot 1 as well as hardwaresafety devices. Furthermore it provides the master-slave robot withhaptic properties. Additional perception of the operation can be fedback to the master.

The surgical (slave) robot 1 comprises a supporting frame 8 which isconnected to a proximal end of the operating table 6, and two instrumentmanipulators 20 connected to the frame 8, representing the hands of thesurgeon, by which is meant that the surgeon controls the motion of theinstruments present on the respective instrument manipulators 20 of theslave robot 1 by manually actuating the controllers on the master systemwith both his hands. If required more instrument manipulators can beadded in order to be able to switch between respective manipulators orto operate on a different region. For relatively simple operations oneinstead of two instrument manipulators can be provided on the robot 1.Manipulators can for example be added in order to support anendo-illuminator or micro-endoscope. Above the eye of the patient onwhich the surgery needs to be performed there is room for a light pathof a microscope or for the microscope itself.

In FIG. 2 an instrument manipulator 20 of the surgical robot 1 is shownin more detail. The instrument manipulator 20 comprises two main parts:a manipulator front end 22 and manipulating means 24. Manipulating means24 comprise a linkage system which can be manipulated by means ofactuators in order to manipulate the manipulator front 22 end withrespect to the (eye 5 of the) patient's body. Manipulating means 24 arefixed to the supporting frame 8 by connecting base plate 23 to thesupporting frame 8.

The manipulating means 24 are designed such that a remote centre ofmotion (RCM) is realised at the point of entry into the eye 5. At thiscentre of motion a cannula 7 is presented, which cannula 7 is fixed atthe lower extremity of the front end 22. With such a defined and stiffconnection between the cannula and the front end of the instrumentmanipulator, a very safe switching of instruments can be realised, aswill be explained in more detail underneath, wherein the focus of thesurgeon can be held within the organ of intervention, thereby reducingthe chance of error.

FIG. 3 shows the manipulator front end 22 of the instrument manipulator20 in more detail. In FIG. 4 the front end 22 is shown in exploded view.In FIG. 3 with respect to FIG. 4 two less instruments 42 are shown forclarity purposes. The front end 22 comprises a base body 36 on which aninstrument receiver 34 for a surgical instrument 42, 42′ is movably,along the longitudinal direction of base body 36, provided. Furthermorean instrument container 30 is provided which can be rotated with respectto the longitudinal direction of base body 36, which longitudinaldirection is displayed by means of dashed line 37 in FIG. 4. Base body36 is directly fixed to the manipulating means 24.

Instrument container 30 is part-cylindrical shaped and includes fivecontainer holders 32, 32′ for receiving therein four surgicalinstruments 42 and one surgical instrument 42′. Container 30 is providedwith a guide 31 on an upper end face as well as on a lower end face (notshown), over which guide 31 rollers 46 having a circumferential groovewhich is adapted to the shape of guide 31 are provided, which rollersare connected to base body 36. Container 30 is movable with respect tothe base body 36 by actuating motor 121. Motor 121 is operativelyconnected via a gear 122 to a gearing (not shown) present on backsurface 39 of container 30. As an alternative for mentioned motor 121and gear 122, at least one of the rollers 46 can be driven in order torotate container 30 with respect to base body 36. Container holders 32,32′ are provided along an outer surface of container 30. The respectiveholders 32, 32′ are each bounded by two resilient wall parts 33 whichdefine a cylindrical passage and which act as leaf springs for clampinga surgical instrument 42, 42′ in a respective container holder 32, 32′.The instrument container 30 as shown in FIG. 3 has four containerholders 32 for receiving therein four respective instruments 42 and hasone container holder 32′ for receiving therein one instrument 42′.Obviously other numbers of container holders 32, 32′ and differentshaped container holders can be provided on the instrument container 30,depending on the number of different instruments used during theoperation and the specific geometry of the instruments used. Instrumentcontainer 30 can be provided together with instruments in one sterilesealed package, wherein the container can be mounted on the instrumentmanipulator just before the surgical operation. Furthermore the overallshape of the container 30 can be part-cylindrical, fully cylindrical, ormore or less straight.

For facilitating a very easy mounting of a container, whether or notalready including instruments, on the base body 36, two rollers 46 whichare located at the bottom side of the container (at least when mounted)are provided on arms that are pivotably connected to base body 36. Usingsprings located at the pivots of the mentioned arms, the rollers 46 areurged upwards due to the spring force. Two rollers 46 that are locatedat the upper side of container 30 (at least when mounted) are rotatablyconnected to base body 36 but cannot move with respect to base body 36.In order to mount a container 30, the two lower rollers can manually bepivoted downwards against the force of the springs such that space isprovided for fitting container 30 with its two guides 31 in mentionedspace. After positioning the container in between the four rollers 46,the arms of the two lower rollers can be released thus the two lowerrollers then engage the lower guide 31 of the container 30. Mentionedsprings provide a tensioning of lower rollers 46 against lower guide 31which consequently forces upper guide 31 against upper rollers 46 andthus realises a stable and well-defined connection between container 30and base body 36.

Surgical instruments 42 are at least partly cylindrical-shaped and areprovided with an upper cylindrical part 44 of which the diameter isadapted to the inner surfaces of resilient wall parts 33 of a containerholder 32. In the embodiment shown in FIG. 4, four surgical instruments42 are identically shaped, at least regarding their upper part, and onesurgical instrument 42′ has an upper part 44′ having a larger diameter.Therefore container holder 32′ also has a larger dimension compared tothe container holders 32. Surgical instruments 42, 42′ all have a lowercylindrical section having a specific diameter in order to make allinstruments 42, 42′ fit in the instrument receiver 34, as will beexplained below.

Container holders 32, 32′ are shaped such that an instrument 42, 42′ ismovable therein in vertical direction (along the longitudinal direction37 of base body 36). In order to mount an instrument 42, 42′ in one ofthe respective container holders 32, 32′ the respective instrument isslided from below the respective container holder 32, 32′ in upwarddirection until the clamping force between upper section 44, 44′ ofinstrument 42, 42′ and resilient wall parts 33 is such that theinstrument 42, 42′ remains fixed in the respective container holder 32,32′. For increasing smooth entering of an instrument 42, 42′ into aholder 32, 32′ an upper edge of the upper part 44, 44′ of theinstruments is made slightly conical. In order to minimize the risk ofaccidental sliding of an instrument out of a holder 32, 32′, the bottomedge of each wall part 33 of the respective holders is provided with asmall inwardly extending rib, engaging just under the lower edge of theupper part 44, 44′ of the instruments 42, 42′, when the instrument isfully slided into a holder 32, 32′. An instrument to be selected forsurgery can be positioned directly above (in alignment with) theinstrument receiver 34 by actuating rollers 46 as explained above.Instrument selection by rotation of container 30 thus takes place in arevolver-like way.

Instrument receiver 34 is connected to base body 36 by means of aconnector piece comprising a cylindrical part 110 and a guide part 112,which guide part 112 is provided with guide shoes 114 by means of whichthe connector piece and thus the instrument receiver 34 can slide in up-and downward direction along guides 116 on base body 36. In order toaccurately control movement of the instrument receiver 34 alongmentioned guide 116 a motor 123 present on base body 36 can be driven,which motor 123 is, via gears, connected to a schematically shownspindle 124, the gearing on which spindle meshes with a gearing (notshown) present in the guide part 112 of instrument receiver 34.

Cylindrical part 110 is provided with a rotational guide which engagesside wall 67 of connector ring 56 (see FIGS. 5a and 5b ). The mentionedrotational guide thus enables the connector ring 56 and thus theinstrument present in the instrument receiver 34, as will be explainedunderneath, to rotate around its longitudinal axis 37, while therotational guide blocks any other degree of freedom of ring 56. Withincylindrical part 110, furthermore driving means are present which engagegear 66 of connector ring 56 by means of which the rotation ofinstrument receiver 34 can be controlled. Thus, instrument receiver 34can be rotated around its longitudinal axis 37 as well as translatedwith respect to base body 36 along said longitudinal axis 37.

FIGS. 5a and 5b show instrument receiver 34. Clamp ring 50 as shown inFIG. 5b is not shown in FIG. 5a for clarity purposes. An instrument tobe fixed in the instrument receiver 34 can be translated downwards fromabove instrument receiver 34 into the instrument receiver 34, wherebythe instrument moves downwards through bore 63 of push ring 58, throughbore 70 of connector ring 56, and into bore 91 of sleeve 52, which bore91 has a diameter which is adapted to the outer diameter of a lowercylindrical part of a specific instrument 42, 42′.

In assembled state of the instrument receiver 34 three downwardextending pins 61 of push ring 58 extend through bores 68 of connectorring 56 and are fixed into holes 104 of clamp ring 50, thus realizing anassembly of push ring 58 and clamp ring 50. Around pins 61 helicalsprings 59 are present, acting between connector ring 56 and push ring58. Push ring 58 furthermore comprises further pins 62 which extend intofurther bores in connector ring 56. Mentioned further pins 62 are infact only present to keep the further springs 59 positioned, whichfurther springs 59 act between connector ring 56 and push ring 58 andserve in order to increase the spring force in between rings 58 and 56.Each one of the springs 59 thus acts between connector ring 56 and pushring 58. Connector ring 56 and positioning ring 54 slide over outersurface 90 of sleeve 52, whereby the lower end face of positioning ring54 comes to rest against shoulder 92 of sleeve 52. Although positioningring 54 is in assembled state locked in vertical direction betweenshoulder 92 of sleeve 52 and connector ring 56, positioning ring 54 canrotate freely around cylindrical part 90 of sleeve 52. Clamp ring 50slides with an inner surface of bore 102 over the outer diameter ofshoulder 92 and comprises three radial pins 51 that are fixed in holes106, which pins 51 extend into bore 102 and in an assembled state extendinto the groove 80 of positioning ring 54. Bore 102 of clamp ring 50 hasa tapered section at its lower side which, at least in assembled stateof instrument receiver 34, can engage tapered faces 95 of threeresilient lips 94 as will be explained below, which lips 94 are equallydistributed provided on the perimeter of the lower end face of shoulder92 of sleeve 52.

Due to helical springs 59, which are present around pins 61 and 62 andact in between push ring 58 and connector ring 56, the push ring 58together with the clamp ring 50 (due to pins 61 which connect ring 58with ring 50) is forced upwards with respect to the assembly ofconnector ring 56, positioning ring 54 and sleeve 52. The inner taperedsection of clamp ring 50 then forces the resilient lips 94 to moveradially inwards due to the force exerted by helical springs 59 andthus, at least if an instrument is present in sleeve 52, resilient lips94 radially clamp and thereby fix the instrument in instrument receiver34. If push ring 58 on the other hand is pushed downwards (against thedirection of the force exerted by springs 59) with respect to sleeve 52,the inner tapered section of clamp ring 50 disengages from taperedsections 95 of resilient lips 94 which leads to a release of theinstrument clamped in sleeve 52 since the radial clamping force exertedby lips 94 on the instrument is lost.

The special shape of the groove 80 on the outer surface of positioningring 54 leads to a bistable clamping behaviour of instrument receiver34, as will be explained now. Positioning ring 54 has two facingcrown-shaped body parts 85, 87 mutually connected by a cylindrical innerwall part. Groove 80 is thus present in between said crown-shaped bodyparts 85 and 87. Body part 85 is circumferentially provided with obliquesliding edges 81, like sawteeth, on its side facing body part 87. Bodypart 87 is circumferentially provided with slots on its side facing bodypart 85. Oblique sliding edges 81 as well as the ends 78, 82 of therespective slots form stop surfaces for pins 51. The slots having ends78 are relatively longer than the slots having ends 82 thus the stopsurfaces defined by the ends 78 are located further from the oppositesliding edges 81 than the stop surfaces defined by the ends 82. Slotshaving ends 78 and 82, respectively, are provided in an alternatingmanner around the perimeter of positioning ring 54. Opposite each slot asliding edge 81 is present. Pins 51 come to rest against one of theoblique sliding edges 81 of groove 80 each time push ring 58 and thusclamp ring 50 is pushed downwards with respect to sleeve 52 and thusalso with respect to positioning ring 54. Due to the sliding along anoblique sliding edge 81 by each of the respective pins 51 during thedownward movement of pins 51, positioning ring 54 rotates with respectto pins 51 over the length of one edge 81. In order to be complete it ismentioned that rotation of clamp ring 52 around axis 37 is prevented bypins 61 extending through bores 68 of connector ring 56. Rotation ofconnector ring 56 is, as mentioned, controlled by actuation of gear 66,which rotation of ring 56 is blocked during an instrument switch. Whenpush ring 58 is then released, the force exerted by springs 59 pushesthe push ring 58 upwards with respect to sleeve 52 and pins 51 moveupwards in groove 80 and come to rest against either an end 78 or an end82. Consequently each time a downward and upward movement of clamp ring50 with respect to positioning ring 54 is effected, pins 51 end upalternately in one of the slots having ends 78 or 82. This principle cangenerally be compared to the known principle of the push button typeballpoint (pen).

Pins 51 either resting against the end 78 or 82 control the ability toclamp an instrument in sleeve 52. When pins 51 are present against anend 78, clamp ring 50 can move upwards with respect to sleeve 52 oversuch a distance that an instrument can be clamped by the inward motionof resilient lips 94. On the other hand, when radial pins 51 movevertical against an end 82, upward movement of clamp ring 50 withrespect to sleeve 52 is limited such that no radial inward force isexerted by resilient lips 94 on an instrument present within sleeve 52.The advantage of such a bistable behaviour of instrument receiver 34will now be explained by describing an instrument switching operation.

If the instrument 42′ as shown in FIG. 3 needs to be switched by one ofthe instruments 42 as shown in FIG. 3, at first, if not already presentabove instrument receiver 34, the empty container holder 32′ ispositioned directly above (aligned with) the instrument receiver 34 by arotation of the instrument container 30 with respect to base body 36 asdescribed above. Next, instrument receiver 34 is translated upwardsalong guides 116 until upper section 44′ of instrument 42′ enterscontainer holder 32′ of instrument container 30 from below. The clampingforce exerted by resilient walls 33 of container holder 32′ is such thatthe instrument receiver is still able to translate in vertical directionwhile upper section 44′ slides further into instrument holder 32′. Inother words, the clamping force exerted by walls 33 on the instrument islower than the clamping force exerted by lips 94 on the instrument. Whenmoving further upwards, the upper end face 60 of push ring 58 comes intocontact with the lower end face of container holder 32′. When movingeven further upwards, push ring 58 moves downwards with respect tosleeve 52 against the force exerted by springs 59, which leads to adownward motion of clamp ring 50 with respect to sleeve 52, thusreleasing the instrument 42′ from sleeve 52. The clamping force by walls33 now effects fixation of the instrument 42′ in holder 32′. During thisdownward motion of clamp ring 50 with respect to sleeve 52, pins 51 movedownwards from a slot having an end 78 in the direction of theoppositely present edge 81 and positioning ring 54 rotates over oneindex position due to sliding of pins 51 over one length of an edge 81,as explained above. When the instrument receiver 34 is then moveddownwards again, due to the rotated position of positioning ring 54,during this downward movement radial pins 51 come to rest against a stopsurface of the adjacent slot, having an end 82, resulting in alimitation of upward movement of clamp ring 50 with respect to sleeve 52and thereby prevention of effecting a radial inward force on theinstrument by resilient lips 94. Thus, instrument receiver 34 movesdownward while instrument 42′ then stays clamped in container holder32′.

When instrument receiver 34 is moved downwards over a sufficientdistance (meaning until instrument receiver 34 is completely out ofrange of instrument 42′), instrument container 30 is rotated such thatthe desired instrument 42 comes to lie directly above instrumentreceiver 34. Then instrument receiver 34 moves upwards again until upperend face 60 of push ring 58 contacts a lower end face of the respectivecontainer holder 32. At this time the instrument 42 has slided intosleeve 52. During this upward action, analog as described above, pushring 58 is moved downwards with respect to sleeve 52 and consequentlyradial pins 51 index one position further with respect to positioningring 54. When the instrument receiver 34 is moved downwards again,radial pins 51 become bounded at the relatively higher location of anend 78 in a slot of positioning ring 54, as a result of which clamp ring50 is able to move over such a distance upwards with respect to sleeve52 that clamp ring 50 can effect radial inward force on resilient lips94 which lead to a firm clamping engagement of the instrument 42 withinsleeve 52. Downward movement of instrument receiver 34 pulls theinstrument 42 out of the container holder 32 since the clamping force bythe lips 94 is higher than the clamping force by walls 33, includinglocking force effected by the above-mentioned rib present on walls 33.The switched instrument 42 can now be moved (further) downwards into theeye of the patient and the surgery can continue. A switching operationas described above proceeds fully automated and in practice takes a fewseconds.

As a precautionary measure movement (rotation) of container 30 withrespect to base body 36 is prevented in case an instrument is pulled outof that one of the container holders 32, 32′ that is positioned in linewith the instrument receiver 34. To realise this a locking element isprovided acting between the container holder 30 and the base body 36,comprising a spring-tensioned pin 130 that is provided on base body 36,which pin 130 engages a flat upper surface of container 30. Mentionedupper surface comprises pawl-shaped inserts, present at the location ofeach one of the container holders 32, 32′. The inserts have an upper endwhich is flat and coplanar with the upper surface, at least in case aninstrument is present in the respective container holder. In caseinstruments are present in each one of the container holders 32, 32′thus a flat path is realized over which path pin 130 can slide andcontainer 30 thus can rotate with respect to base body 36. In caseduring an instrument switch an instrument is however pulled out of acontainer holder, as described above, the pawl drops down over apre-determined distance into a thereto provided space in the material ofcontainer 30, thereby creating a hole in the upper surface of container30. As a result of this, the pin 130, which is located directly abovementioned pawl, is urged into the hole created by the pawl and thusblocks rotation of the container 30 with respect to base body 36. Incase an instrument is pushed back into a container holder as describedabove, the pawl is urged upwards again until its upper end is coplanarwith the upper surface of container 30, thereby restoring the path overwhich pin 130 can slide and thereby thus releasing the locking betweencontainer 30 and base body 36. Using mentioned pin 130 in combinationwith pawl-shaped inserts a very accurate locking is provided which takesplaces automatically, meaning no operator action is required. Thisresults in an increased safety level during instrument switches.

What is claimed is:
 1. A surgical robot for performing a medicalprocedure, comprising: (a) an instrument manipulator comprising amanipulator front end, wherein said manipulator front end comprises abase body defining a longitudinal axis with a proximal end and a distalend; (b) a container movably connected to said base body near saidproximal end of said longitudinal axis, wherein said container comprisesan instrument holder for holding a surgical instrument, wherein saidinstrument holder has a through-hole for holding said surgicalinstrument, wherein said through-hole has a proximal end and a distalend in the direction of said longitudinal axis, and wherein at leastpart of said surgical instrument when held in said instrument holderextends passed said distal end of said through-hole and towards saiddistal end of said base body; (c) an instrument receiver for receivingsaid surgical instrument from below said distal end of said respectivethrough-hole of said instrument holder, wherein said instrument receivercomprises a clamping mechanism, wherein said clamping mechanism canclamp said surgical instrument when said clamping mechanism is changingfrom a passive no-clamping state to an active clamping state; (d) acannula connector with a proximal end and a distal end parallel withsaid longitudinal axis, said cannula connector is a rigid connectormounted to said distal end of said base body, said surgical instrumentto go through said cannula connector, wherein said cannula connectorremains distal to said instrument receiver, wherein said cannulaconnector can be fixated onto a cannula to establish a connectionbetween said base body and said cannula via said cannula connector,wherein said cannula is also parallel with said longitudinal axis; and(e) a linear guide to actively guide said instrument receiver towardssaid instrument holder where said instrument receiver can actively clampsaid surgical instrument through said clamping mechanism, wherein saidlinear guide can actively guide said instrument receiver with saidclamped surgical instrument in longitudinal direction towards saidcannula connector, and wherein the translation of said instrumentreceiver towards said cannula connector while said surgical instrumentis clamped by said clamping mechanism of said instrument receiver causessaid surgical instrument to be released from said instrument holder. 2.The surgical robot as set forth in claim 1, wherein said cannula can befixated onto a human or an animal body.
 3. The surgical robot as setforth in claim 2, wherein said human or animal body is an eye.
 4. Thesurgical robot as set forth in claim 2, wherein a spatial positionbetween said base body and said human or animal body is fixed whenswitching one of said surgical instruments.
 5. The surgical robot as setforth in claim 1, wherein said through-hole is at least partcylindrical.
 6. The surgical robot as set forth in claim 1, wherein saidcontainer rotation is in a plane perpendicular to said longitudinalaxis.
 7. The surgical robot as set forth in claim 1, wherein saidsurgical robot is part of a master-slave operating system.
 8. Thesurgical robot as set forth in claim 1, wherein the inner diameter ofsaid cannula connector changes over the length of said cannula connectorbetween said proximal and distal ends.